Page 19 - On Location 2022 Benefit Guide

Employee Benefit Costs

Weekly

Medical Employee Contributions
Direct Access 4 Direct Access 3 EPO HSA 13

Employee Only $58.50 $56.00 $45.00
Employee & Spouse $140.00 $134.00 $107.00
Employee & Child(ren) $105.00 $100.50 $82.00
Family $189.50 $181.00 $141.00

MetLife Dental Employee Contributions EyeMed Vision Plan
Employee Only $2.75 Employee Only $0.77
Employee & Spouse $5.00 Employee & Spouse $1.46
Employee & Child(ren) $5.25 Employee & Child(ren) $1.53
Family $7.25 Family $2.25

Allstate Group Indemnity Plan Cigna Group Life Insurance

Employee Only $3.41
Employee & Spouse $9.24
All $0.23
Employee & Child(ren) $5.90
Family $9.98

Cigna Supplemental Life Insurance
Employee & Spouse Per
Rate per $1,000 of Coverage
$1,000 of Coverage
<20 $0.090
20-24 $0.090
25-29 $0.102
30-34 $0.102
35-39 $0.131
40-44 $0.169
45-49 $0.242
50-54 $0.380
55-59 $0.626

60-64 $0.971
65-69 $1.580
70-74 $2.748
75-79 $4.619
80+ $8.027

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