Page 46 - OpenX 2022 Book of Benefits
P. 46
COST BREAKDOWN
Employee
Total OpenX Employee Payroll
Coverage Level Monthly Monthly Monthly Deduction
Cost Contribution Contribution (24 Pay
Periods)
Employee Only $677.07 $677.07 $0.00 $0.00
Employee + Spouse/DP $1,414.76 $1,209.76 $205.00 $102.50
Aetna Medical CDHP
Employee + Child(ren) $1,280.68 $1,095.68 $185.00 $92.50
Employee + Family $$2,018.38 $1,728.38 $290.00 $145.00
Employee Only $803.19 $668.19 $135.00 $67.50
Employee + Spouse/DP $1,678.29 $1,393.29 $285.00 $142.50
Aetna Medical PPO
Employee + Child(ren) $1,519.22 $1,259.22 $260.00 $130.00
Employee + Family $2,394.35 $1,984.35 $410.00 $205.00
Employee Only $706.33 $706.33 $0.00 $0.00
Employee + Spouse/DP $1,475.95 $1,270.95 $205.00 $102.50
Aetna Medical HMO
Employee + Child(ren) $1,336.04 $1,151.04 $185.00 $92.50
Employee + Family $2,105.66 $1,815.66 $290.00 $145.00
Employee Only $456.44 $456.44 $0.00 $0.00
Employee + Spouse/DP $1,004.16 $844.16 $160.00 $80.00
Kaiser HMO
Employee + Child(ren) $912.87 $767.87 $145.00 $72.50
Employee + Family $1,369.31 $1,149.31 $220.00 $110.00
Employee Only $39.13 $39.13 $0.00 $0.00
Employee + Spouse/DP $75.84 $64.84 $11.00 $5.50
Aetna Dental
DPPO Low
Employee + Child(ren) $116.45 $99.45 $17.00 $8.50
Employee + Family $150.02 $127.02 $23.00 $11.50
