Page 5 - Catalyst 2022 Benefit Guide

Medical Option Rates

Blue Cross Blue Shield

2022 Rate Information - The Company Pays 100% of the Silver Option S667CHC medical plan
Employee Only Amount. Employees enrolling in Gold Option H.S.A, G9K4CHC medical Plan will
pay to difference between the two plans.

Example 1: If you are age 35 and enroll in the Silver Plan, the Company pays 100% of your Employee
only $532.07 monthly cost (You Pay for any Dependents).
Example 2: If you enroll in the Gold Option and are age 35 your cost monthly is $53.90. This is $582.16
(cost to enroll in Gold) minus the $532.07 (cost to enroll in Silver).

Silver Option S667CHC 6,000 Gold Option G9K4CHC 2,800
AGE Rate AGE Rate AGE Rates AGE Rates

0-14 $333.09 40 $ 556.45 0-14 $364.45 40 $ 608.84
15 $362.70 41 $ 566.90 15 $396.84 41 $ 620.27
16 $374.02 42 $ 576.92 16 $409.23 42 $ 631.23
17 $385.34 43 $ 590.85 17 $421.61 43 $ 646.47
18 $397.53 44 $ 608.27 18 $434.95 44 $ 665.53
19 $409.72 45 $ 628.73 19 $448.29 45 $ 687.92

20 $422.35 46 $ 653.12 20 $462.11 46 $ 714.60
21 $435.41 47 $ 680.55 21 $476.40 47 $ 744.61
22 $435.41 48 $ 711.90 22 $476.40 48 $ 778.91
23 $435.41 49 $ 742.81 23 $476.40 49 $ 812.74
24 $435.21 50 $ 777.64 24 $476.40 50 $ 850.85
25 $437.15 51 $ 812.04 25 $478.31 51 $ 888.49
26 $445.86 52 $ 849.92 26 $487.83 52 $ 929.93

27 $456.31 53 $ 888.24 27 $499.27 53 $ 971.86
28 $473.29 54 $ 929.60 28 $517.85 54 $1,017.11
29 $487.22 55 $ 970.96 29 $533.09 55 $1,062.37
30 $494.19 56 $1,015.81 30 $540.71 56 $1,111.44
31 $504.64 57 $1,061.09 31 $552.15 57 $1,160.99
32 $515.09 58 $1,109.42 32 $563.58 58 $1,213.87

33 $521.62 59 $1,133.37 33 $570.73 59 $1,240.07
34 $528.59 60 $1,181.70 34 $578.35 60 $1,292.95
35 $532.07 61 $1,223.50 35 $582.16 61 $1,338.68
36 $535.55 62 $1,250.93 36 $585.97 62 $1,368.70
37 $539.04 63 $1,285.33 37 $589.78 63 $1,406.33
38 $542.52 64 $1,306.23 38 $593.59 64 $1,429.20
39 $549.49 39 $601.22

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