Page 24 - TriStar Energy-2023-Benefit Guide-V26(WLP)-LRI
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Benefits Costs (continued)
Your payroll contributions for dental and vision benefits are shown below.
Dental
Cigna Dental High Plan Weekly Bi-weekly
with Orthodontia
Team Member Only $5.34 $10.68
Team Member & Spouse $10.54 $21.08
Team Member & Child(ren) $12.69 $25.38
Team Member & Family $19.84 $39.68
Cigna Dental Low Plan Weekly Bi-weekly
Team Member Only $4.75 $9.50
Team Member & Spouse $9.38 $18.75
Team Member & Child(ren) $11.29 $22.57
Team Member & Family $17.65 $35.31
Vision
Cigna Vision Plan Weekly Bi-weekly
Team Member Only $1.24 $2.48
Team Member & One $2.36 $4.72
Team Member & 2 or More $3.60 $7.20
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