Page 47 - OpenX 2022 Book of Benefits
P. 47
Employee
Total OpenX Employee Payroll
Coverage Level Monthly Monthly Monthly Deduction
Cost Contribution Contribution (24 Pay
Periods)
Employee Only $65.53 $53.53 $10.00 $5.00
Employee + Spouse/DP $125.24 $106.24 $19.00 $9.50
Aetna Dental
DPPO High
Employee + Child(ren) $158.60 $134.60 $24.00 $12.00
Employee + Family $238.79 $202.79 $36.00 $18.00
Employee Only $9.28 $9.28 $0.00 $0.00
Employee + Spouse/DP $17.84 $14.84 $3.00 $1.50
Ameritas Vision
Employee + Child(ren) $15.92 $13.42 $2.50 $1.25
Employee + Family $24.48 $20.48 $4.00 $2.00
EMPLOYEE & SPOUSE VOLUNTARY COVERAGE MONTHLY COST (POST-TAX)
Ages Per $1,000 in coverage
<29 $0.71
30-34 $0.84
35-39 $0.97
40-44 $1.18
45-49 $1.69
50-54 I $2.55
55-59 $4.25
60-64 $6.27
65-69 9.920
70+ $18.52
Child Coverage Per $4,000 of coverage $0.58
