Page 6 - HIMSS 2021 Annual Benefits Enrollment
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BENEFIT CONTRIBUTIONS
MEDICAL PER PAYCHECK
BCBS HIGH DEDUCTIBLE PPO + HSA
Employee Only $35.90
Employee + Spouse or Domestic Partner $130.96
Employee + Child(ren) $120.25
Employee + Family $191.37
BCBS PPO PLAN
Employee Only $82.13
Employee + Spouse or Domestic Partner $239.65
Employee + Child(ren) $220.06
Employee + Family $350.21
HMO PLAN
Employee Only $34.90
Employee + Spouse or Domestic Partner $127.31
Employee + Child(ren) $116.91
Employee + Family $186.05
DENTAL PER PAYCHECK
Employee Only $2.87
Employee + Spouse or Domestic Partner $5.86
Employee + Child(ren) $6.43
Employee + Family $9.42
VISION PER PAYCHECK
Employee Only $2.72
Employee + Spouse or Domestic Partner $5.17
Employee + Child(ren) $5.44
Employee + Family $7.99
OPTIONAL DEPENDENT LIFE INSURANCE PER PAYCHECK
$2,000 Increments to a maximum of
$10,000 $0.083 per $2,000
OPTIONAL LIFE AND ACCIDENTAL DEATH & DISMEMBERMENT
Cost of this benefit varies based on age, benefit election, and salary. Personalized
per pay costs will be displayed on the group benefits enrollment website.
ACCIDENTAL AND CRITICAL ILLNESS INSURANCE
Cost of this benefit varies based on benefit election and salary. Personalized per
pay costs will be displayed on the benefits enrollment website.
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MEDICAL PER PAYCHECK
BCBS HIGH DEDUCTIBLE PPO + HSA
Employee Only $35.90
Employee + Spouse or Domestic Partner $130.96
Employee + Child(ren) $120.25
Employee + Family $191.37
BCBS PPO PLAN
Employee Only $82.13
Employee + Spouse or Domestic Partner $239.65
Employee + Child(ren) $220.06
Employee + Family $350.21
HMO PLAN
Employee Only $34.90
Employee + Spouse or Domestic Partner $127.31
Employee + Child(ren) $116.91
Employee + Family $186.05
DENTAL PER PAYCHECK
Employee Only $2.87
Employee + Spouse or Domestic Partner $5.86
Employee + Child(ren) $6.43
Employee + Family $9.42
VISION PER PAYCHECK
Employee Only $2.72
Employee + Spouse or Domestic Partner $5.17
Employee + Child(ren) $5.44
Employee + Family $7.99
OPTIONAL DEPENDENT LIFE INSURANCE PER PAYCHECK
$2,000 Increments to a maximum of
$10,000 $0.083 per $2,000
OPTIONAL LIFE AND ACCIDENTAL DEATH & DISMEMBERMENT
Cost of this benefit varies based on age, benefit election, and salary. Personalized
per pay costs will be displayed on the group benefits enrollment website.
ACCIDENTAL AND CRITICAL ILLNESS INSURANCE
Cost of this benefit varies based on benefit election and salary. Personalized per
pay costs will be displayed on the benefits enrollment website.
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