Page 12 - 2019 Benefit Guide Non-CA
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WHAT ARE YOUR 2019 RATES?
CIGNA MEDICAL PLAN OPTIONS - PER PAY PERIOD COST
PLAN EMPLOYEE ONLY EMPLOYEE & EMPLOYEE & EMPLOYEE & FAMILY
CHILDREN
SPOUSE
HMO (OAP IN) $75.00 $325.00 $275.00 $500.00
HSA–Choice Fund $50.00 $240.00 $190.00 $400.00
PPO (OAP) – Open Access Plus $175.00 $482.50 $400.00 $725.00
CIGNA DENTAL PLAN OPTIONS - PER PAY PERIOD COST
PLAN EMPLOYEE ONLY EMPLOYEE & EMPLOYEE & EMPLOYEE & FAMILY
SPOUSE
CHILDREN
PPO – Low Option $19.25 $38.90 $41.38 $62.70
PPO – High Option $27.63 $55.86 $59.41 $90.20
CIGNA VISION PLAN OPTIONS - PER PAY PERIOD COST
PLAN EMPLOYEE ONLY EMPLOYEE & EMPLOYEE & EMPLOYEE & FAMILY
CHILDREN
SPOUSE
PPO $3.31 $6.62 $6.69 $10.67
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