Page 7 - Covered 6 Employee Benefits 2021-2022
P. 7
Employee Contributions
Covered 6 LLC will contribute 50% of the premium for you as an employee, on the base plan. Rates are
effective 12/01/2021-11/30/2022. Contributions toward the cost of benefits are automatically
deducted from your paycheck on a pre-tax basis. Rates below are monthly. The amount depends on
the plan and if you choose to cover eligible family members.
Deductible 5500 HMO (BASE PLAN)
Employee Only $ 117.84
Employee and Spouse $ 400.63
Employee and Child(ren) $ 353.50
Employee and Family $ 589.17
HSA HDHP 2000 HMO
Employee Only $ 210.85
Employee and Spouse $ 605.27
Employee and Child(ren) $ 539.53
Employee and Family $ 868.21
Deductible 1500 HMO
Employee Only $ 215.11
Employee and Spouse $ 614.63
Employee and Child(ren) $ 548.05
Employee and Family $ 880.99
Zero Deductible HMO
Employee Only $ 295.93
Employee and Spouse $ 792.43
Employee and Child(ren) $ 709.69
Employee and Family $ 1,123.44
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