Page 19 - Impact XM 2023 Benefit Guide
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Employee Benefit Costs
Bi-Weekly
Medical Employee Contributions
Direct Access 4 Direct Access 3 EPO HSA 13
Employee Only $132.00 $126.00 $101.00
Employee & Spouse $316.00 $302.00 $240.00
Employee & Child(ren) $237.00 $226.00 $184.00
Family $427.00 $408.00 $317.00
MetLife Dental Employee Contributions EyeMed Vision Plan
Employee Only $6.00 Employee Only $1.53
Employee & Spouse $11.00 Employee & Spouse $2.91
Employee & Child(ren) $11.50 Employee & Child(ren) $3.06
Family $16.00 Family $4.50
Allstate Group Indemnity Plan New York Life Group Life Insurance
Employee Only $6.81
Employee & Spouse $18.48
All $0.46
Employee & Child(ren) $11.79
Family $19.95
New York Life 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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