Page 12 - CPS Benefits Guide
P. 12
Medical Plan
Salary Bands are Based on Your Annual Salary as of June 1, 2017
Montana, Oregon, and Vermont
Only
PPO Plan HSA Plan Out-of-Area Plan
Bi-Weekly Payroll Without Without Without
Deductions With Wellness Wellness With Wellness Wellness With Wellness Wellness
Salary Bands Discount Discount Discount Discount Discount Discount
<$70,000
Employee Only $41 .76 $54 .28 $23 .67 $30 .78 $41 .76 $54 .28
Employee and Spouse $266 .18 $346 .03 $217 .31 $282 .50 $266 .18 $346 .03
Employee and Child(ren) $131 .52 $144 .05 $107 .38 $114 .48 $131 .52 $144 .05
Family $266 .18 $346 .03 $217 .31 $282 .50 $266 .18 $346 .03
$70,000–-$119,999
Employee Only $54 .80 $71 .24 $35 .51 $46 .16 $54 .80 $71 .24
Employee and Spouse $310 .54 $403 .70 $257 .55 $334 .81 $310 .54 $403 .70
Employee and Child(ren) $153 .45 $169 .89 $127 .26 $137 .91 $153 .45 $169 .89
Family $310 .54 $403 .70 $257 .55 $334 .81 $310 .54 $403 .70
$120,000+
Employee Only $67 .85 $88 .20 $47 .35 $61 .55 $67 .85 $88 .20
Employee and Spouse $354 .90 $461 .37 $297 .79 $387 .12 $354 .90 $461 .37
Employee and Child(ren) $175 .36 $227 .97 $147 .14 $161 .35 $175 .36 $227 .97
Family $354 .90 $461 .37 $297 .79 $387 .12 $354 .90 $461 .37
Please note: deductions are based on 24 payroll cycles.
12 2017 Benefits Enrollment
Salary Bands are Based on Your Annual Salary as of June 1, 2017
Montana, Oregon, and Vermont
Only
PPO Plan HSA Plan Out-of-Area Plan
Bi-Weekly Payroll Without Without Without
Deductions With Wellness Wellness With Wellness Wellness With Wellness Wellness
Salary Bands Discount Discount Discount Discount Discount Discount
<$70,000
Employee Only $41 .76 $54 .28 $23 .67 $30 .78 $41 .76 $54 .28
Employee and Spouse $266 .18 $346 .03 $217 .31 $282 .50 $266 .18 $346 .03
Employee and Child(ren) $131 .52 $144 .05 $107 .38 $114 .48 $131 .52 $144 .05
Family $266 .18 $346 .03 $217 .31 $282 .50 $266 .18 $346 .03
$70,000–-$119,999
Employee Only $54 .80 $71 .24 $35 .51 $46 .16 $54 .80 $71 .24
Employee and Spouse $310 .54 $403 .70 $257 .55 $334 .81 $310 .54 $403 .70
Employee and Child(ren) $153 .45 $169 .89 $127 .26 $137 .91 $153 .45 $169 .89
Family $310 .54 $403 .70 $257 .55 $334 .81 $310 .54 $403 .70
$120,000+
Employee Only $67 .85 $88 .20 $47 .35 $61 .55 $67 .85 $88 .20
Employee and Spouse $354 .90 $461 .37 $297 .79 $387 .12 $354 .90 $461 .37
Employee and Child(ren) $175 .36 $227 .97 $147 .14 $161 .35 $175 .36 $227 .97
Family $354 .90 $461 .37 $297 .79 $387 .12 $354 .90 $461 .37
Please note: deductions are based on 24 payroll cycles.
12 2017 Benefits Enrollment
