Page 23 - TriStar Energy-2023-Benefit Guide-V26(WLP)-LRI
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Benefits Costs
Your payroll contributions for medical benefits are shown below.
Medical
Option 1 Weekly Bi-weekly
Cigna $3,000 CDHP with HSA
Team Member Only $23.30 $46.60
Team Member & Spouse $145.71 $291.42
Team Member & Child(ren) $103.24 $206.48
Team Member & Family $155.25 $310.50
Option 2 Weekly Bi-weekly
Cigna $4,000 CDHP with HSA
Team Member Only $14.29 $28.59
Team Member & Spouse $124.24 $248.47
Team Member & Child(ren) $80.98 $161.96
Team Member & Family $130.47 $260.94
Option 3 Weekly Bi-weekly
Cigna $5,000 Buy-Up PPO Plan
Team Member Only $49.90 $99.80
Team Member & Spouse $208.83 $417.66
Team Member & Child(ren) $151.69 $303.39
Team Member & Family $278.78 $557.57
Spouses eligible for group medical coverage through their employer are not eligible for coverage on the Tri Star Energy
Medical Plans.
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