Page 13 - CPC Behavioral Healthcare 2022 - 2023 Benefits Guide

EMPLOYEE CONTRIBUTIONS

EMPLOYEE BENEFIT PER PAY RATE SHEET
st
EFFECTIVE JULY 1 , 2022

Coverage Tier 10 Month Rate 12 Month Rate
Program

Medical - EPO Employee Only $29.10 $23.50
Employee + Spouse $62.29 $50.31
Employee + Child(ren) $62.29 $50.31
Family $72.00 $58.15

Medical - POS Employee Only $52.97 $42.78
Employee + Spouse $110.57 $89.31
Employee + Child(ren) $110.57 $89.31
Family $120.39 $97.23

Medical – Direct Employee Only $134.16 $108.36
Access
Employee + Spouse $262.86 $212.31
Employee + Child(ren) $262.86 $212.31

Family $272.38 $220.00
Dental – Premier Employee Only $3.78 $3.06
$1,000
Employee + One $5.71 $4.62
Dependent
Family $9.51 $7.68
Dental – Premier Employee Only $5.23 $4.22

$1,750
Employee + One $8.28 $6.69
Dependent
Family $13.76 $11.11
Dental – Flagship Employee Only $2.02 $1.63

Employee + One $3.66 $2.95
Dependent
Family $6.24 $5.04
Vision - PPO Employee Only $2.24 $1.81
Employee + Spouse $3.76 $3.04

Employee + Child(ren) $3.87 $3.12
Family $6.33 $5.11

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