Page 41 - ABC Company 2018 Open Enrollment Guide

Health Plan Rate Schedule
Below is a schedule of semi-monthly payroll contributions for the following benefits:
UnitedHealthcare Medical
Basic HSA Plan
$13
Preferred HRA Plan
Select POS Plan
Employee
$64
$121
Employee and Spouse
$32
$139
$26
$64
$134
$186
$268
Employee and Child(ren)
$258
Family
$350
UnitedHealthcare Dental
Basic Dental Plan
Enhanced Dental Plan
Employee
$6
$12
Employee and Spouse
$12
$25
Employee and Child(ren)
$17
$32
Family
$26
$50
Vision Service Plan (VSP)
Basic Vision Plan
Enhanced Vision Plan
Employee
$2
$4
Employee and Spouse
$4
$8
Employee and Child(ren)
$4
$8
Family
$8
$12
Long-Term
Disability
Buy-Up
Semi-Monthly Rate
Rate/$100
$0.06
Supplemental Life Rate Schedule
Employee & Spouse Semi-Monthly Rate
Age of Employee
Rate/$1,000
Age of Employee
Rate/$1,000
15-29
$0.025
50-54
$0.13
30-34
$0.025
55-59
$0.215
35-39
$0.035
60-64
$0.355
40-44
$0.055
65-69
$0.57
45-49
$0.085
70-99
$1.13
Dependent Child Family Rates
Rate/$1,000
$0.155
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