Page 19 - AB Mauri 2022 Benefits Guide MOIL
P. 19
2022 Benefits Enrollment
Employee Contributions
Medical Monthly Cost
Cigna HMO Plan
(for employees who reside in Cigna OAP Plan* High Deductible Health Plan/
HSA
an HMO service area)
Employee Only $168 $198 $218
Employee + Child(ren) $323 $376 $419
Employee + Spouse $347 $400 $453
Family $492 $578 $643
* If you reside in an HMO service area but elect the Cigna OAP plan, you will be charged a higher monthly cost. Cost of coverage is available in
Paycom.
Tobacco users will cost an additional $60 per month.
Medical monthly costs will be discounted $12.50 to $50 if you earn 10,000+ points per quarter through Virgin
Pulse.
Spouses that have coverage available through their own employer will cost an additional $200 per month if
enrolled.
Dental Monthly Cost Optional Life
Dental PPO Your cost of coverage is based on your age and the
Employee Only $8.65 coverage amount you elect for yourself and your
Employee + Child(ren) $16.62 dependents. Cost of coverage is available in Paycom.
Employee + Spouse $16.04
Family $23.08
Vision Monthly Cost
Vision
Employee Only $0.89
Employee + Child(ren) $1.79
Employee + Spouse $1.77
Family $2.82
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Employee Contributions
Medical Monthly Cost
Cigna HMO Plan
(for employees who reside in Cigna OAP Plan* High Deductible Health Plan/
HSA
an HMO service area)
Employee Only $168 $198 $218
Employee + Child(ren) $323 $376 $419
Employee + Spouse $347 $400 $453
Family $492 $578 $643
* If you reside in an HMO service area but elect the Cigna OAP plan, you will be charged a higher monthly cost. Cost of coverage is available in
Paycom.
Tobacco users will cost an additional $60 per month.
Medical monthly costs will be discounted $12.50 to $50 if you earn 10,000+ points per quarter through Virgin
Pulse.
Spouses that have coverage available through their own employer will cost an additional $200 per month if
enrolled.
Dental Monthly Cost Optional Life
Dental PPO Your cost of coverage is based on your age and the
Employee Only $8.65 coverage amount you elect for yourself and your
Employee + Child(ren) $16.62 dependents. Cost of coverage is available in Paycom.
Employee + Spouse $16.04
Family $23.08
Vision Monthly Cost
Vision
Employee Only $0.89
Employee + Child(ren) $1.79
Employee + Spouse $1.77
Family $2.82
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