Page 30 - 2018 Carlstar Benefit Guide
P. 30
30 BENEFITS ENROLLMENT • 2018
Employee Contributions
Medical 2018—HSA Silver Plan
1
Plan Options Waive/No Coverage Ee Only Ee + Spouse Ee + Child(ren) Ee + Family
Employee standard rate $0.00 $72.42 $140.64 $120.55 $190.60
HAQ discount only — $63.19 $122.18 $111.32 $172.14
Tobacco free discount only — $62.42 $130.64 $110.55 $180.60
HAQ and tobacco free discounts — $53.19 $122.18 $101.32 $162.14
Vision Insurance Dental Insurance
2
2
Plan Options Waive/No Ee Only Ee + Ee + Ee + Plan Options Waive/No Ee Only Ee + Ee + Ee +
Coverage Spouse Child(ren) Family Coverage Spouse Child(ren) Family
Vision plan $0.00 $2.76 $5.24 $5.52 $8.49 Dental plan $0.00 $3.38 $6.74 $7.08 $10.46
1 Amounts are shown on a bi-weekly per pay period basis. HAQ discounted rates are valid upon completion for both spouse and employee by deadline (if applicable).
2 Amounts are shown on a bi-weekly per pay period basis.
Supplemental Life Insurance
Employee and Spouse Rates
Rate (per $1,000 of Total Coverage)
If you elect Additional Life insurance, your monthly Employee Employee
premium rate for this plan is indicated in the table below. Age Tobacco Non-Tobacco Spouse
<30
Premiums for this coverage will be deducted directly from 30–34 $0.051 $0.051 $0.043
$0.068
$0.077
$0.051
your paycheck. 35–39 $0.111 $0.077 $0.077
40–44 $0.180 $0.120 $0.128
Child(ren) Rates 45–49 $0.317 $0.214 $0.240
50–54 $0.514 $0.351 $0.377
If you elect Dependent Life insurance for your eligible 55–59 $0.822 $0.548 $0.599
child(ren), your monthly Premium rate for this coverage is 60–64 $1.310 $0.882 $0.967
$1.489
$1.370
$2.020
65–69
$0.80 for $10,000 per month, regardless of the number of 70–74 $3.689 $2.500 $2.714
eligible children covered. 75+ $5.855 $3.946 $4.280
Voluntary AD&D
Coverage Cost Per $1,000 Of Coverage
Employee only $0.033
Employee and dependents $0.035
Enrollments must be made online at
www.portal.adp.com
Employee Contributions
Medical 2018—HSA Silver Plan
1
Plan Options Waive/No Coverage Ee Only Ee + Spouse Ee + Child(ren) Ee + Family
Employee standard rate $0.00 $72.42 $140.64 $120.55 $190.60
HAQ discount only — $63.19 $122.18 $111.32 $172.14
Tobacco free discount only — $62.42 $130.64 $110.55 $180.60
HAQ and tobacco free discounts — $53.19 $122.18 $101.32 $162.14
Vision Insurance Dental Insurance
2
2
Plan Options Waive/No Ee Only Ee + Ee + Ee + Plan Options Waive/No Ee Only Ee + Ee + Ee +
Coverage Spouse Child(ren) Family Coverage Spouse Child(ren) Family
Vision plan $0.00 $2.76 $5.24 $5.52 $8.49 Dental plan $0.00 $3.38 $6.74 $7.08 $10.46
1 Amounts are shown on a bi-weekly per pay period basis. HAQ discounted rates are valid upon completion for both spouse and employee by deadline (if applicable).
2 Amounts are shown on a bi-weekly per pay period basis.
Supplemental Life Insurance
Employee and Spouse Rates
Rate (per $1,000 of Total Coverage)
If you elect Additional Life insurance, your monthly Employee Employee
premium rate for this plan is indicated in the table below. Age Tobacco Non-Tobacco Spouse
<30
Premiums for this coverage will be deducted directly from 30–34 $0.051 $0.051 $0.043
$0.068
$0.077
$0.051
your paycheck. 35–39 $0.111 $0.077 $0.077
40–44 $0.180 $0.120 $0.128
Child(ren) Rates 45–49 $0.317 $0.214 $0.240
50–54 $0.514 $0.351 $0.377
If you elect Dependent Life insurance for your eligible 55–59 $0.822 $0.548 $0.599
child(ren), your monthly Premium rate for this coverage is 60–64 $1.310 $0.882 $0.967
$1.489
$1.370
$2.020
65–69
$0.80 for $10,000 per month, regardless of the number of 70–74 $3.689 $2.500 $2.714
eligible children covered. 75+ $5.855 $3.946 $4.280
Voluntary AD&D
Coverage Cost Per $1,000 Of Coverage
Employee only $0.033
Employee and dependents $0.035
Enrollments must be made online at
www.portal.adp.com
