Page 46 - 17BE 2930
P. 46
2017 Benefits Enrollment
Employee Contributions
Medical 2017—HRA Red Plan
Accepting No New Participants for 2017
Plan Options Waive/No Ee Only Ee + Ee + Ee +
Coverage Spouse Child(ren) Family
Employee standard rate $0.00 $82.40 $161.10 $139.23 $217.93
HAQ discount only — $73.17 $142.63 $130.00 $199.47
Tobacco free discount only — $72.40 $151.10 $129.23 $207.93
HAQ and tobacco free — $63.17 $132.63 $120.00 $189.47
discounts
Amounts are shown on a bi-weekly per pay period basis. HAQ discounted
rates are valid upon completion for both spouse and employee by deadline (if
applicable).
Medical 2017—HSA Silver Plan
Plan Options Waive/No Ee Only Ee + Ee + Ee +
Coverage Spouse Child(ren) Family
Employee standard rate $0.00 $69.14 $133.26 $114.04 $178.16
HAQ discount only — $59.91 $114.79 $104.81 $159.70
Tobacco free discount only — $59.14 $123.26 $104.04 $168.16
HAQ and tobacco free — $49.91 $104.79 $94.81 $149.70
discounts
Amounts are shown on a bi-weekly per pay period basis. HAQ discounted
rates are valid upon completion for both spouse and employee by deadline (if
applicable).
Dental Insurance
Ee +
Ee +
Ee +
Plan Options Waive/No Ee Only Spouse Child(ren) Family
Coverage
Dental plan $0.00 $3.38 $6.74 $7.08 $10.46
Amounts are shown on a bi-weekly per pay period basis.
Vision Insurance
Waive/No Ee + Ee + Ee +
Plan Options Coverage Ee Only Spouse Child(ren) Family
Vision plan $0.00 $2.76 $5.24 $5.52 $8.49
Amounts are shown on a bi-weekly per pay period basis.
46
Employee Contributions
Medical 2017—HRA Red Plan
Accepting No New Participants for 2017
Plan Options Waive/No Ee Only Ee + Ee + Ee +
Coverage Spouse Child(ren) Family
Employee standard rate $0.00 $82.40 $161.10 $139.23 $217.93
HAQ discount only — $73.17 $142.63 $130.00 $199.47
Tobacco free discount only — $72.40 $151.10 $129.23 $207.93
HAQ and tobacco free — $63.17 $132.63 $120.00 $189.47
discounts
Amounts are shown on a bi-weekly per pay period basis. HAQ discounted
rates are valid upon completion for both spouse and employee by deadline (if
applicable).
Medical 2017—HSA Silver Plan
Plan Options Waive/No Ee Only Ee + Ee + Ee +
Coverage Spouse Child(ren) Family
Employee standard rate $0.00 $69.14 $133.26 $114.04 $178.16
HAQ discount only — $59.91 $114.79 $104.81 $159.70
Tobacco free discount only — $59.14 $123.26 $104.04 $168.16
HAQ and tobacco free — $49.91 $104.79 $94.81 $149.70
discounts
Amounts are shown on a bi-weekly per pay period basis. HAQ discounted
rates are valid upon completion for both spouse and employee by deadline (if
applicable).
Dental Insurance
Ee +
Ee +
Ee +
Plan Options Waive/No Ee Only Spouse Child(ren) Family
Coverage
Dental plan $0.00 $3.38 $6.74 $7.08 $10.46
Amounts are shown on a bi-weekly per pay period basis.
Vision Insurance
Waive/No Ee + Ee + Ee +
Plan Options Coverage Ee Only Spouse Child(ren) Family
Vision plan $0.00 $2.76 $5.24 $5.52 $8.49
Amounts are shown on a bi-weekly per pay period basis.
46
