Page 8 - Ampact 2022 Benefit Guide

Medical Insurance Contributions

Employee contributions for each medical plan are illustrated below. Employees working 30 hours or more a week
are classified as full time. Medical plan premiums are deducted from your paycheck on a pre-tax basis. These rates
are based on 24 pay period deductions each year.

$500 – $25 PPO Plan Full Time Employee Part Time Employee
(30+ hours) (20-29 hours)
Employee $ 81.02 $ 162.04
Employee + Spouse/DP $ 291.67 $ 372.69
Employee + Child(ren) $ 192.83 $ 273.85
Family $ 356.49 $ 437.51

$1500- 100% Non-Embedded Full Time Employee Part Time Employee
HSA Plan (30+ hours) (20-29 hours)
Employee $ 80.49 $ 160.99
Employee + Spouse/DP $ 289.77 $ 370.26
Employee + Child(ren) $ 191.57 $ 272.06
Family $ 354.16 $ 434.66

$2,800 – 100% Embedded Full Time Employee Part Time Employee
HSA Plan (30+ hours) (20-29 hours)
Employee $ 73.19 $ 146.39
Employee + Spouse/DP $ 263.49 $ 336.69
Employee + Child(ren) $ 174.20 $ 247.40
Family $ 322.05 $ 395.25

8 6

Effective August 1, 2022-July 31, 2023