Page 19 - Impact XM 2022 Benefit Guide

Employee Benefit Costs

Bi-Weekly

Medical Employee Contributions
Direct Access 4 Direct Access 3 EPO HSA 13

Employee Only $117.00 $112.00 $90.00
Employee & Spouse $280.00 $268.00 $214.00
Employee & Child(ren) $210.00 $201.00 $164.00
Family $379.00 $362.00 $282.00

MetLife Dental Employee Contributions EyeMed Vision Plan
Employee Only $5.50 Employee Only $1.53
Employee & Spouse $10.00 Employee & Spouse $2.91
Employee & Child(ren) $10.50 Employee & Child(ren) $3.06
Family $14.50 Family $4.50

Allstate Group Indemnity Plan Cigna Group Life Insurance

Employee Only $6.81
Employee & Spouse $18.48
All $0.46
Employee & Child(ren) $11.79
Family $19.95

Cigna Supplemental Life Insurance
Employee & Spouse Per
Rate per $1,000 of Coverage
$1,000 of Coverage
<20 $0.090
20-24 $0.090
25-29 $0.102
30-34 $0.102
35-39 $0.131
40-44 $0.169
45-49 $0.242
50-54 $0.380
55-59 $0.626

60-64 $0.971
65-69 $1.580
70-74 $2.748
75-79 $4.619
80+ $8.027

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