Page 5 - Interior Architects-2022-23-Benefit Guide
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Benefit Costs
Your per pay period payroll contributions for medical, dental and vision benefits are shown here.
Cigna HDHP
Cigna EPO
w/ HSA
Cigna EPO LocalPlus Cigna PPO Cigna HDHP LocalPlus Kaiser CA
HMO
w/ HSA
Network**
Medical Network**
Employee Only $64.82 $54.82 $205.55 $45.87 $35.87 $64.82
Employee + 1* $194.97 $179.96 $540.15 $151.36 $136.36 $194.97
Employee + $307.23 $287.23 $770.83 $275.21 $255.21 $307.23
Family*
Dental Cigna Platinum PPO Cigna Gold PPO
Employee Only $11.09 $5.21
Employee + 1* $24.09 $12.57
Employee +
Family* $45.55 $25.66
Vision VSP Vision
Employee Only $2.10
Employee + 1* $3.67
Employee +
Family* $6.47
*The IRS requires that any portion of the premium an employer funds to cover a domestic partner and/or a domestic partner’s dependent child(ren) be included in the
employee’s gross income for the calculation of federal income taxes and FICA employment taxes. Additionally, any portion of the premium an employee pays for a
domestic partner and/or a domestic partner’s child(ren) must be paid for with after-tax dollars.
**LocalPlus Plans available for employees within LocalPlus Network service areas.
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