Page 8 - Benefits Guide
P. 8
Pre-Tax Bi-Weekly Employee Contributions
Choice Care PPO Choice Care POS
Base Plan Buy-Up Plan Base Plan Buy-Up Plan
Employee $32 .49 $64 .76 $17 .64 $36 .37
Employee and Spouse $144 .41 $208 .94 $114 .71 $152 .16
Employee and Child(ren) $116 .88 $176 .58 $89 .41 $124 .05
Family $195 .49 $287 .46 $153 .18 $206 .54
Tobacco Surcharge
As you enroll for beneits, you must complete a tobacco afidavit and
indicate whether you use tobacco. Tobacco includes cigars, pipes,
cigarettes, snuff, snus, dip, chewing tobacco, and vapor cigarettes.
In order for the surcharge to be waived you must be tobacco free for at
least 90 days.
If you are currently a tobacco user you will be subject to the tobacco
surcharge, however; you are provided the opportunity to participate in the
Humana Tobacco Cessation Program, at no charge to you, or participate
in a physician approved program. You must complete the program in
order to be deemed tobacco free.
If you complete the program within 3 months following your May 1,
2017 effective date, or within 3 months of your enrollment date if hired
after April 1, you will receive a 1-time reimbursement for the 3 months
of tobacco surcharge you paid, and you will pay the discounted medical
premium for the remainder of the plan year.
8 2017–18 Benefits Enrollment
Choice Care PPO Choice Care POS
Base Plan Buy-Up Plan Base Plan Buy-Up Plan
Employee $32 .49 $64 .76 $17 .64 $36 .37
Employee and Spouse $144 .41 $208 .94 $114 .71 $152 .16
Employee and Child(ren) $116 .88 $176 .58 $89 .41 $124 .05
Family $195 .49 $287 .46 $153 .18 $206 .54
Tobacco Surcharge
As you enroll for beneits, you must complete a tobacco afidavit and
indicate whether you use tobacco. Tobacco includes cigars, pipes,
cigarettes, snuff, snus, dip, chewing tobacco, and vapor cigarettes.
In order for the surcharge to be waived you must be tobacco free for at
least 90 days.
If you are currently a tobacco user you will be subject to the tobacco
surcharge, however; you are provided the opportunity to participate in the
Humana Tobacco Cessation Program, at no charge to you, or participate
in a physician approved program. You must complete the program in
order to be deemed tobacco free.
If you complete the program within 3 months following your May 1,
2017 effective date, or within 3 months of your enrollment date if hired
after April 1, you will receive a 1-time reimbursement for the 3 months
of tobacco surcharge you paid, and you will pay the discounted medical
premium for the remainder of the plan year.
8 2017–18 Benefits Enrollment
