Page 9 - 2022 Insurity OE Guide FINAL

Monthly Medical Employee Contributions

HDHP/HSA Plan 1 HDHP/HSA Plan 2 POS Plan 3
$3,000 / $6,000 $2,000 / $4,000 $1,000 / $3,000
Tier 1 – Base Annual Salary Less Than $60,000
EE Only $85 $115 $250
EE + Child(ren) $165 $225 $490
EE + Spouse $185 $250 $545
EE + Family $220 $300 $650
Tier 2 – Base Annual Salary $60,000 – $89,999
EE Only $115 $150 $330
EE + Child(ren) $225 $290 $640
EE + Spouse $250 $325 $715
EE + Family $300 $390 $860
Tier 3 – Base Annual Salary $90,000 and Above
EE Only $165 $210 $390
EE + Child(ren) $320 $410 $760
EE + Spouse $355 $455 $845
EE + Family $430 $545 $1,010

A $200 per month
spousal surcharge
applies if your spouse has
medical coverage available
through their employer and you
cover them through Insurity.
This surcharge does not apply
if both spouses are employed
by Insurity. The rates above
do not include this
additional charge.

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