Page 11 - 2015 Enrollment Guide

American Air Filter

2015 Premium

2015 Premium Rates Rates
The per pay period pre-tax premium rates for the medical, dental, and vision plans
are listed below.

2015 Hourly Employee Premiums (weekly rates)
Lumenos HDHP
National PPO Consumer PPO HSA

Employee Only $32.31 $22.25 $8.74
Employee + Spouse/DP $69.80 $48.05 $18.89
Employee + Child(ren) $61.07 $42.04 $16.52
Employee + Family $103.40 $71.19 $27.98
Dental Vision
Employee Only $1.38 $1.67
Employee + Spouse/DP $2.98 $2.42
Employee + Child(ren) $3.94 $3.18
Employee + Family $6.78 $4.85

2015 Salary Employee Premiums (bi-weekly rates)

National PPO Consumer PPO Lumenos HDHP
HSA
Employee Only $64.63 $44.49 $17.49
Employee + Spouse/DP $139.59 $96.10 $37.77
Employee + Child(ren) $122.14 $84.09 $33.05
Employee + Family $206.81 $142.37 $55.96

Dental Vision
Employee Only $2.76 $3.34
Employee + Spouse/DP $5.97 $5.85
Employee + Child(ren) $7.94 $6.35
Employee + Family $13.56 $9.69

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