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FULL-TIME AND PART-TIME (30 OR MORE HOURS PER WEEK)
Benefit Contributions - Medical
Find the plan option (HSA, HMO, etc.) across the top and then scan down to find your salary tier. Your monthly contribution is labeled “Employee Contribution.” The amount in the next column to the right is your total monthly premium. The Company pays the difference.
HMO IL
Employee Total Contribution Premium
Medical Coverage Monthly Contribution
HMO Blue Texas & Blue Choice Select PPO
PPO
Employee Total Contribution Premium
$61 $655 $172 $1,377 $145 $1,249 $243 $1,967
Employee Total Contribution Premium
$115 $655 $309 $1,377 $249 $1,249 $439 $1,967
Employee Total Contribution Premium
$155 $655 $390 $1,377 $327 $1,249 $556 $1,967
Employee Total Contribution Premium
$182 $655 $446 $1,377 $380 $1,249 $639 $1,967
Employee Total Contribution Premium
$196 $655 $472 $1,377 $407 $1,249 $678 $1,967
Employee Total Contribution Premium
$268 $655 $627 $1,377 $558 $1,249 $900 $1,967
HMO-NM, OK
Tier 1 ($39,999 and under)
Employee Total Employee Contribution Premium Contribution
Total Premium
$570 $1,199 $1,087 $1,712
Total Premium
$570 $1,199 $1,087 $1,712
Total Premium
$570 $1,199 $1,087 $1,712
Total Premium
$570 $1,199 $1,087 $1,712
Total Premium
$570 $1,199 $1,087 $1,712
(Illinois only)
Employee $48 Employee/Spouse $139 Employee/Children $115 Employee/Family $206
$597 $1,254 $1,134 $1,791
$51 $653 $145 $1,384 $120 $1,258 $215 $1,995
Tier 2 ($40,000 – $55,000)
$46 $137 $110 $193
Tobacco User Surcharge $50 Per Month
Employee Total Contribution Premium
Employee Total Employee Contribution Premium Contribution
Employee $84 Employee/Spouse $240 Employee/Children $181 Employee/Family $331
$597 $1,254 $1,134 $1,791
$90 $653 $260 $1,384 $194 $1,258 $357 $1,995
Tier 3 ($55,001 – $75,000)
$87
$243
$190
$341
Tobacco User Surcharge $50 Per Month
Employee Total Contribution Premium
Employee Total Employee Contribution Premium Contribution
Employee $115 Employee/Spouse $305 Employee/Children $242 Employee/Family $426
$597 $1,254 $1,134 $1,791
$124 $653 $332 $1,384 $260 $1,258 $460 $1,995
Tier 4 ($75,001 – $150,000)
$118 $306 $248 $432
Tobacco User Surcharge $75 Per Month
Employee Total Contribution Premium
Employee Total Employee Contribution Premium Contribution
Employee $137 Employee/Spouse $349 Employee/Children $282 Employee/Family $488
$597 $1,254 $1,134 $1,791
$146 $653 $376 $1,384 $302 $1,258 $525 $1,995
Tier 5 ($150,001 and up)
$139
$348
$290
$494
Tobacco User Surcharge $75 Per Month
Employee Total Contribution Premium
Employee Total Employee Contribution Premium Contribution
Employee $146 Employee/Spouse $368 Employee/Children $302 Employee/Family $517
$597 $1,254 $1,134 $1,791
$157 $653 $398 $1,384 $324 $1,258 $557 $1,995
$152 $373 $311 $529
Tobacco User Surcharge $75 Per Month
Tier 6 (Executive Leadership Group - Vice Presidents and above)
Employee Employee/Spouse Employee/Children Employee/Family
Employee Total Employee Contribution Premium Contribution
$220 $597 $230 $524 $1,254 $549 $454 $1,134 $483 $777 $1,791 $813
Total Employee Premium Contribution
$653 $208 $1,384 $507 $1,258 $428 $1,995 $720
Total Premium
$570 $1,199 $1,087 $1,712
Tobacco User Surcharge $75 Per Month