Page 21 - Leona Arizona Employment Group Flipbook

Employee Premiums

Employee Premiums
12-Month Pay Cycle Rates

Coverage Level Base Plan Buy-Up Plan CHDP/HRA Plan Delta Dental Superior Vision
Employee Only $15.00 $53.00 $0 $0 $0.00

Employee + Spouse $53.00 $117.00 $22.50 $15.59 $2.57
Employee + Child(ren) $42.50 $92.50 $12.50 $14.43 $2.71

Family $74.50 $156.50 $42.50 $20.25 $3.98
Waiver $83.34 per pay $83.34 per pay $83.34 per pay $20.84 per pay None

10-Month Pay Cycle Rates

Coverage Level Base Plan Buy-Up Plan CHDP/HRA Plan Delta Dental Superior Vision

Employee Only $18.00 $63.60 $0 $0 $0.00
Employee + Spouse $63.60 $140.40 $27.00 $18.71 $3.08

Employee + Child(ren) $51.00 $111.00 $15.00 $17.32 $3.25
Family $89.40 $187.80 $51.00 $24.30 $4.78

Waiver $83.34 per pay $83.34 per pay $83.34 per pay $20.84 per pay None

Semi-Monthly Rates

Group Legal & ID Theft Plans Per Pay Premium
Individual Voluntary Benefits
ID Theft Shield $6.48
The cost of your Individual Voluntary Benefits
ID Theft Shield Upgrade $7.48 (i.e., Whole Life, Critical Illness and Accident
Insurance) is determined at time of enrollment
Standard Plan $7.48
and is deducted on an after-tax basis.
Standard Plan Upgrade $7.98
ID Theft Shield + Standard Plan $12.45

ID Theft Shield + Standard Plan Upgrade $12.95
Expanded Plan $11.98

Bundle ID Theft Shield & Legal $14.45
ID Theft Shield + Expanded Plan $16.95

ID Theft Shield + Expanded Plan + 24/7 $17.45

Note: Part-time employees are eligible for the group rates but are
billed at home for Group Legal and Identity Theft benefits.

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