Page 17 - MB Aerospace Benefit Guide + Notices 2021

Benefit costs

Monthly Medical Rates

Medical MBA Centivo Plus Plan MBA HSA High Plan MBA HSA Low Plan
Employee Only $174.10 $94.50 $56.51
Employee + Spouse $432.47 $246.34 $129.96
Employee + Child(ren) $385.47 $219.57 $115.84
Family $582.89 $332.02 $175.17
Semi-Monthly Medical Rates

Medical MBA Centivo Plus Plan MBA HSA High Plan MBA HSA Low Plan
Employee Only $87.05 $47.25 $26.08
Employee + Spouse $216.24 $123.17 $59.98
Employee + Child(ren) $192.74 $109.79 $53.46
Family $291.45 $166.01 $80.85
Weekly Medical Rates

Medical MBA Centivo Plus Plan MBA HSA High Plan MBA HSA Low Plan
Employee Only $40.18 $21.81 $13.04
Employee + Spouse $99.80 $56.85 $29.99
Employee + Child(ren) $88.95 $50.67 $26.73
Family $134.51 $76.62 $40.42
Dental Monthly Rate Semi-Monthly Rate Weekly Rate
Employee Only $8.79 $4.40 $2.03
Employee + Spouse $23.34 $11.67 $5.39
Employee + Child(ren) $28.75 $14.38 $6.63
Family $45.20 $22.60 $10.43
Vision Monthly Rate Semi-Monthly Rate Weekly Rate
Employee Only $7.17 $3.57 $1.65
Employee + Spouse $10.39 $5.20 $2.40
Employee + Child(ren) $10.39 $5.20 $2.40
Family $18.63 $9.31 $4.30
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